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HomeMy WebLinkAbout188139 DOHN CONSTRUCTION INC - INSURANCE CERTIFICATE (20)DOHNCON-01 LPREW ACORo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 06/21 /2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PFS Insurance Group PHA ° No, ); (970) 635-8400 FAX Ne :(970) 635-9401 4848 Thompson Parkway Suite 200 Johnstown, CO 80534 E . info@mypfsinsurance.com INSURED Dohn Construction, Inc. DCI Residential, LLC ►NSURERC: 2642 Midpoint Drive INSURERD: Fort Collins, CO 80525 INSURER E COVERAGES CFRTIFICATF NUMBER- REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBRI POLICY EFF POLICY EXP R TYPE OF INSURANCE IN POLICY NUMBER MM/D /YYYY M / LIMITS A X COMMERCIAL GENERAL LIABILITY II—+ CLAIMS -MADE X OCCUR X Blanket Addl Insured_ X BlanketWBiver GEN'L AGGREGATE LIMITAPPLIES PER: POLICY �X JECT LOC OTHER: IRS7255 10/01/2016 10/01/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea • 100r000 $ MED EXP (Any oneperson) $ 6,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,0001000 A AUTOMOBILE LIABILITY ANY AUTO 1 Z57255 OWNED SCHEDULED AUTOS ONLY AUTOS X AUTOS ONLY X A�TOS ONLY glanket Add[ Blanket Waiver X Insured X 10/01 /2016 10/01 /2017 COMBINED SINGLE LIMIT (Ea accidW)X $ 1,000,000 BODILY INJURY Per erson $ BOODILY INJURY Per accident BODILY (Parr. dent SAGE $ A X UMBRELLA LIAB XOCCUR EXCESS LIAB CLAIMS -MADE 1 P57255 DED i X RETENTION $ 10,000 10/01 /2016 1 10/01/2017 EACH OCCURRENCE $ 10,000,000 AGGREGATE 10,000,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE � FFICER/MEMBER EXCLUDED. (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 3055407 07/01/2017 07/01/2018 i X I PER OTH- E.L. EACH ACCIDENT 1,000,000 $ 1,000,000 III 1,000,000 $ E.L. DISEASE -EA EMPLOYEE E.L. DISEASE -POLICY LIMIT A Installation 1057255 10/0112016110/0112017 Limit i 100,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) If required by written agreement, the certificate holder Is included as additional insured for ongoing operations under general liability. CERTIFICATE HOLDER I;AN ;tLLA I IUN City of Fort Collins P.O. Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE iia�_ ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DOHNCON-01 LPREWITT '4CORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/21 /2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. tf SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PFS Insurance Group 4848 Thompson Parkway Suite 200 AJC, No, Ext : (970) 635-9400 FAX , No):(970) 635-9401 Johnstown, CO 80534 Ajp�R SO: info@mypfsinsurance.com INSURERISI AFFORDING COVERAGE NAIC # INSURED Dohn Construction, Inc. DCI Residential, LLC 2642 Midpoint Drive Fort Collins, CO 80525 INSURER F : rnVPPAr%PC CFF?TIGIRATF N1IRRF2FR• RFVI91r1N NI IMRFR• 415 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTFINSD MMD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 $ PREMI ETORENTED 100,000 CLAIMS -MADE XJ OCCUR 1R57255 10/01/2016 10/01/2017 MED EXP (Any oneperson) $ 5,000 Blanket Addl Insured PERSONAL & ADV INJURY 1,000,000 $ _ X Blanket Waiver GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY " 1 zaf LOC PRODUCTS -COMP/OP AGG 2,000,000 i OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMB 1,000,000 BODILY INJURY Perperson) $ X ANY AUTO 1Z57255 10/01/2016 OWNED SCHEDULED AUTOS ONLY AUTOS 10/01/2017 BODILY INJURY Per accident PReOPPERdTYDAMAGE $ $ X HIRED I X NON -OWNED AUTOS ONLY AUTOS ONLY XBlanket Addl Blanket Waiver Insured X A X UMBRELLA LIAB X OCCUR EXCESSLWB CLAIMS -MADE 11P57255 EACH OCCURRENCE $ 10,000,000 10/01/2016 10/01/2017 AGGREGATE $ 10,000,000 DED X RETENTION $ 10,000: $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY IN ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 3055407 X PERTUTE OTH- 07/01/2017 07/01/2018 1,000,000 E.L. EACH ACCIDENT' $ _ 1 OOOOOO E.L. DISEASE - EA EMPLOYEE , , If yes, describe under DESCRIPTION OF OPERATIONS below _ _ E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Builders Risk _ _ 1X57255 10101/2016' 10/01/2017 Any One Loc. 5,000,000 A Leased/Rented Equip 1057255 10/01/2016 10/01/2017 $1,000 Deductible 100,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: City of Fort Collins Proposal No. 8546. If required by written contract the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder, is named as Additional Insured for ongoing operations and completed operations under General Liability and Designated Insured under Automobile Liability (except Hired and Non -Owned Automobile). A Waiver of Subrogation applies to those named above for General Liability, Automobile Liability and Workers' Compensation. Contractual Liability is included. Umbrella provides excess coverage over the General Liability, Automobile Liability and Employers Liability. This insurance will apply on a primary, non-contributory basis. Lhd\INoiLNJAeJa;I City of Fort Collin Purchasing Division 215 North Mason Street, 2nd Floor Fort Collins, CO 80524 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD